Great revision result! - Beirut, LB

I booked my primary procedure with a well-known LA...

12 Jul 2014

11 days post

I booked my primary procedure with a well-known LA surgeon who visits the Gulf region and has excellent before/afters (and charges extremely high fees)

I went into the original surgery seeking a reduction and a reshaping. My nose wasn't huge but was too big for my face, I also had a small dorsal bump, a bulbous tip and an overhanging collumella, plus a deviated septum. I requested a reduction in projection and refinement of the bridge and tip.

You always hear "if you hate the shape when the cast comes off, then chances are you won't be happy". At the first cast removal, my reaction was unimpressed but held my judgement while I waited for the swelling to go down. By 3 months, the shape had settled - and I wasn't happy; after 6 months I saw no further improvements. The result was not terrible, but it was far from good and especially disappointing given the price paid. The surgeon also dismissed all my concerns, constantly saying it was a great result. The twisted tip was brushed away with the excuse that I had an "exceptionally asymmetric face" (which isn't true). The excess supratip fullness was "swelling" - but it never resolved even after steroid injections - the tip was also hard as a rock with more tissue on one side than the other.The projection hadn't been reduced at all and I was told that reducing was not possible and would widen the nose. (Which is a bit ridiculous given tons of other patients get a reduction in projection)

The final result had various issues including
- over reduced bridge
- under reduced tip resulting in too such supratip and columellar volume as well as too much projection
- convex shape to the tip, very unflattering in photographs and worse when smiling
- visible twisting and asymmetry of the tip (nostril height asymmetry was present before original op, but after the tip was both twisted and off center)
- breathing difficulties
- rock hard tip

I consulted a variety of surgeons for revisions. I had 3 options - either simple fillers to the bridge to balance out the tip, complete reconstruction including grafts to the bridge and alar rims, or simple reduction of the tip. I chose the latter as it was the simplest surgery and shortest recovery (and I am hoping the result holds up over time)

I had a closed rhinoplasty done under local anaesthetic in Beirut, Lebanon. I would have preferred an open operation but my surgeon prefers to do closed rhinos to reduce swelling and scar tissue. Having it done under local was not particularly pleasant as my body is somewhat impervious to both sedatives and local anaesthetics so after the first 15 minutes the sedative had worn off and close to the end of the procedure my nose was starting to wake up - ouch! You can, of course, still feel all the pressure and scraping of the tissue even when you can't feel the pain. My surgeon removed a lot of scar tissue left from the previous op and discovered that my septum was broken!! However, apart from IV paracetamol immediately after the surgery, I did not require painkillers aside from panadol a couple of times a day

I was extremely swollen around the eyes for 4 days post-op - even more so than the primary op. The tip swelling has quickly reduced and by 1 week I was presentable - but the internal healing inside the nose has been problematic. I still have 4 or 5 stitches inside the nose that have not dissolved at 10 days post op and I really feel like these stitches are actually preventing proper healing of the internal wounds, as the skin is trying to heal over and around the stitches. The tip nose is still tender and sore inside and out and there are lumps all around the stitches as well as the wounds not looking like they're completely closed. I also got a small area of skin necrosis on the tip of the nose which is healing fine but will probably leave a small pitted scar that will require subscision or fraxel treatment

Visually the result is looking pretty good. It was not possible to completely correct the asymmetry but the projection and shape are much improved. I am hoping over time the roundness of the tip will reduced and it will become more pointy and refined. My ideal nose is one with a supratip break and I am not sure this will emerge but even so, at the moment I am happy. I might get some fillers to widen the bridge at the 3 month mark.

Please PM me if you'd like to know more about my surgery or my surgeons

Some more pics

13 Jul 2014

12 days post

Some more pictures to show how my nose ended up twisted and off-center after the primary op. Although I had a slight asymmetry of the nostrils, the tip was straight. After the primary op, the surgeon claimed the tip twisting was due to my 'asymmetric face'.
We didn't correct the tip in the revision it would have required a much more extensive surgery. I might try to camouflage it with filler at a later state

Swelling going down quickly

14 Jul 2014

13 days post

I guess my doctor was right about the swelling going down more quickly after a closed op. Here is the profile at 13 days

Stitches still annoying!

27 Jul 2014

26 days post

One of my stitches got infected, making it really sore and tender. I had my friend who is a doc give me an ointment; it's now a lot better. The interior of the nose is much improved but one stitch is still really causing issues and interfering with the healing. I wish I could get it removed! Can't wait til it falls out so my poor nose can heal inside :(

Most of the tip swelling seems to have resolved which is quite amazing after only 4 weeks

I have a small red mark and a pit on the tip where I had skin necrosis :( Will deal with it when it's more healed with filler and laser as necessary!

Will try and post some more pics soon

4 weeks!

1 Aug 2014

1 month post

So, the annoying stitch came out a couple of days ago and since then, everything has been much more comfortably and the inside of the nose was finally able to heal.

The result is looking good. There hasn't been a huuuge change but the swelling has visibly gone down between week 2 and week 4. The resulting profile is super cute, I'm hoping the tip will get pointier and less rounded, even if it doesn't then the result is still great

As I declined a graft during the revision, I now have to decide whether to get filler in the over-reduced bridge. It will balance the tip, but I will lose some of the turned up look

Love my new nose

6 Aug 2014

1 month post

Swelling continues to resolve - I love my new nose!!! It photographs wonderfully too. My before pics don't actually show how bad my nose was before revision - at rest it wasn't disastrous but the tiniest hint of a smile and the angle would change and the entire tip was very peak like and turned down. Every time I got photographed I was tipping my nose up and not smiling, desperately trying to find an angle at which it looked ok. No more :)